99100153 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF C;)PIIRTINO BUILDING-ELF.CFRICAI. .RMIT
BUILDING DIVISION APPLICATION/PERMIT PLUMBING-MFICHANICAI• SOOOI
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRESS: SANITARY NO. APPI.ICAI'ION SUBMITTAL DATE
3 u L0
OWNS 'S NAME: 1'IIONIi: CONIIONCI'ORS NAME: LIC NO:
D6UR-N —LL, INC uN1xrn.N
ARCHITECTIENGINI:FA: LIC NO ADDR 5��� SENO �/ ❑
CONTACT: PHONE: BUILDING PERMIT INFO
C l I on enl aPaid by Applht(InBLDG ICC PLUMB MECH
� -C4 I
UI SEDCONTRACIOR.SDECV.RATON Q'ry ELECTRIC PERMIT FEE
I hvehy affum Thu mn
I am liceed umkr Provisio ,of Chgsae v(commenting JOB DESCRIPTION
N Senimr TBW I of IBvision J of me B voo,,,ant Po,sumis Cad'W mY Iicenr<is RFSIDFNTIAI c
u:O PERMIT ISSUANCE
� iu full face udc .�• ❑SFDWL ❑KITCHEN RFMODEL
FQUV faccme Cl t Lic.N gprlJpNCBS_RFSIDENTAIL ❑AUDITION (]PLUhIBING NEPIPE
yZ� Due
ARCHITECTS CI.kRATION tor
❑MULTI-UNIT ❑STRUCTURAL.
F Z IuNcrvad mYfX'ARCHITcTS Whic recoil` PANELS MODIFICATION
UP TO 300 AMPS [I INTERIOR ❑CHIMNEY REPAIR
OZFO I.icemcd Pm('ssimlal KIT-IOOOAMPS IMPROVEMENT I]SWIMMING POOLS
Q 1lertby off mWN am au pEfnom the CuotncOal is nu Law fa tNc OVER IOW AMPS El BATH REAIOUEIJREPAIR ❑DEMOLITION
K 01 U fdlowiag rtasan.(Section 7031.5.Bmd i W hVfmions C :Any city a mudy SIGNS ELECTRICAL [I OTHER
which rclry'Lcs a permit m I..,mer,impre"dendi a rtpeir any sOLclum
piorto Eta mrorna.dxo rtquirts the apmm rastuh It to Rk•owed smsc�m SPECIAL CIRCUITNISC. N
fly Ilwhcislicecaalpurauanttothepmvisi^mnfl Cmir tar's Ltcenrelaw(ChaPter9 COMMERCIAL:
VY00 (cnmmeeeingwimSmim I000)d Dlvuian3af the irclsurd l'mfdaium Cak7m TEMP.MCTERORPOLEB:ST.
d a e IY Ila!k is exempt therefrom anW the bmix fur the cgN exemMln^ /`^Y vinluinn of ❑NEN'BLDG/ADDITION ❑DEMOLITION
^y Smtion]03l5hyuny Lwic-atttfurapemtitsuh' c.Ile opplicwttuacivil pemhy of POWER DEVICES OTENANT ❑FOOD SERVICE
nor.man live Mari dolWts WWI, IMPROVEMENT
FZQ ❑ I,duwtler of me praprny.amY amPl with wages as deir We oro Pemuian. SWIMMING POOL ELECTRIC
' 5 willdu me work andthe Do,
i akdaow tto act
net
of C:1 OTHER
F
Prafauaas co,:The Crmsrvcrl I.icenxe law rhea nut app1Y ru w owner of OIffLETS-SWITCHES-FIXTURES
hi,.who build.u vicloI m t mn,end who Jon such wort himself m Nnmgh
his own empinyaz,pnwiJM Ih rLch imPrnvcmcnss ort nx ImatdcJ nr ufferzJ fa NEW RESIDBMIAL F,LECIR SQ IT
sok.IL hmaever,the huitxng unpmvemem is wlJ within mcycaof axnplctinn,dw SQ.E ARIA USQ.IT.
nwa
r-huilhr willMwt Nen of proving That N:did not hold ar ingnuve for par- 1i^(> pire
pcac n[SW'). D a
❑Lax owner of the Ieny,alts ccclwaivdy<nnlrmting with I'acnrcd almmalnn so L'
construes Ih prajc (S.I.II114,Hunireu aml Itofurniala Crdc:)'rne Cunmmmr'x I:
e wwda: Xapply to an nwar^r1�Pleny whr mlBd.ailn Ilk m.. FEE OCT, �
eaa
wMcantract asuchpnrjn'InwilM1ucxltraCla(n)Iicr:Ilrcdpuntlw la 2a
Liamw ,SDA CE V 99g
El an xeny^Latter Sea ,It k u
Oversee Dategownr �_ /1I VN.UA PION
WORKER'S COMPENSATION UECLARADON O.
1 hrehY alto^order penally of rxjary am of IIx:full wing ILII
❑Ihner.ad will maint.m.CcaiMmc of Coawrnn-if 1-Ire for WaAel a. DRAINS-1tiI'ORINS IYPI!C( . ' ON
anti^¢as Ixovideil for by Senilm 371C of she Ls o,Coda,fur the Peffornance
wod for which oris pe.,I is ixsaNd. 'S
I M1oe and will m+inmin Worker's Canpemasioo Insuran<,as
3700eflhe WNe CMe.Gxlhe f afunnanceofsM work forwhichs 1 -1 NC.GO S OCC.CROUP NPN
My Weak de Grcnpcnr_winr}I_n_vuLancr:cnor, rpard Poky��;arS.91-07 GAS-F.A.SYSTEM OVER Y ) -15-13
4f1CiEUIIFICAATE�OF EXEMPTION MOM WORKERS'
COMPENSATION INSURANCEGRPASF/INDUSTRL N'A 'INTERCEPTOR BUILDING DIVISION ITIS _
(This,,Vaoa need not he cam*ted tribe Pcmpl ldorax hu (STUB OREASE TRAP
a Icv) PLANCIIIfCK FEE
I cenif,No in liteofa^umoal dw.Mfur wty'Jrel x permitk rasued.1.hall SEWER-SANIT -STORM EA.200 FL
not employ Ivry perram in troy mercer moss �w
1nM1�rnlhjce In me Wwminmpen
kC - ENERGY FEE
nation I.-ofc.lifoosia.Dara / WATER HEA WNEN' IELEC R
ZA,lictrnt I GRADING LYE
y NOTICE TO APPUCA eftcr meting dila Ccnif Ic of Exemption,you sMu1d WATER S M/IREATING('^ .becvne whjm SOILS FEE
tui Io efx Contpcmetion Pro,Water of the Isbur Cole,you muR
laMwim cepnii w ith such provisiorta^r this pcmut shall be dxmN rtvokM. WAIF SERVICE
Z) Z CONSTRUCTION LENDING AGENCY N RBSIUFNTIALPLMB. SQ.Fp. PAID Uatc Rec6m0
IherebYtrRntbal lhereutreaawetiuokalin or e',rfomm�ceof
P the work fa which Nu ricnall u ixsucd(Sec,I C)
TOTAL
ULiori Name
I1ndeYs AddrtxS TOTAL
} 6. I certify OVI 1 ad this applicaion not suite Thu the above information is BUILDING FEE
F' h cornecrltrgrte IYw'im all city eM aaLnty oNimrces.rrd.,,,•hws muting to QTY MECHANICAL PERMIT FEE SEISMIC FEE
U handing rnnwruclina.and henmy aulhri-rtPrae-1111 ofthu city to emn aPrr lha
abe,escationcl pmpmy for impccriun panpso ' PERMIT ISSUANCE ELECTRIC IEE
(We)agree to save,iMwnify and keep huWeu the City of Cupenirw agaiml
lartaitic.judiraa^LL cosu ad expemn which may in any way weeks,aga-said City ALTER OR ADD TO MECH. PLUMBING FEE
in c�sryurax of III granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT AIR HANDLING UNIT(TO 10.000 M.1) MECHANICAL FIM
SOURCE REGO
AIR HANDLING UNIT(OVER 10.000 CFM CONSTRUCTION TAX
Iaelurt of Appliant/ConOaclnr ue EXHAUST HOOD(WMUCT) HOUSING MITIGATION FEE
HAZARDOUS MATERIALS DISCLOSURE
Will IIIc applicant or forum WlWingoccupwt Stam or hudle haouJlwx rwmrial HEATING UNIT(TO U),UIO BT
to defired by the C.,orlino Munkipcl Crile.ChalYa 9,12,and the Halm ud Sa@lY
Cak,Scnioa 25532101 HEATING UNIT(OVER IW. BTU)
❑Ycz - VENTILATIONFANISI TRESID) PAID IAtc RaciPrN
WIII ma opplk m or forum building(ceup nt use,inPsear or d iaea which BOILER-COMP(3 OR IW,000 PTU)
aril to zai air conwmiwnts as Jebned by Ile Buy Arca Air Qualisy Monagcnent 'TIII
Doti.? BOILER-COM OVER (I,1XCBTU))
Ely"
Ihavc revel she h:vnnlnua nvamriWx is urxks Cha rfi.9,5 of she Cali- AIRCOND' ONER ISSUANCE
m.25533n ane
beadaHsrellh or Safcry Gila,$a I'lo.255115,2'any 'and25,53/.I aro I,to IreIIflhe NI1W IDENTIAL MIRII. SQ.FT.
hullriln6 dxx nil curremly hove L lemma,mw is i.v any mHnm'ihllhy In nail'y Ilereculxms
of
,ha nyulncna`tNo not+r to iwotal of a ce/ �Iel 1911.71
c I Y.
(hvne umaizW agcnl rDuro T(lI'AL: ISSUEDN
OFFICE
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: RnS: Sub: Blk: Lot:35913134.00
INVOICE DATE...... : 10/28/1999
REFERENCE ID # .. . : 99100153
SITE ADDRESS . .... : 10343 TULA LANE
SUBDIVISION . ..... .
CITY ... . . ... ..... : CUPERTINO
IMPACT AREA ...... .
OWNER ... . . . . . . . ..: GIDWAHI
ADDRESS .... .. . . . .:
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
CONTRACTOR . . . . ...: LIC q
COMPANY .... . . .. ...
ADDRESS . . . . . . . . ..:
CITY/STATE/ZIP . .. . ,
TELEPHONE . . . . . . . .:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
_______________ ___ _________ ____________ ___________
BUSLIC P 86.00 0.00 86.00 .
EPERMITFEE P 35.52 0.00 35.52
____________ ___________
121.52 0.00 '121.52
E ID DESCRIPTION---_----- VOICE ID -_DESCRIPTION
... ................... .....ee. ...... ............
1 ROUGH ELECTRICAL 501 FINAL ELECTRICAL ENERGY
505 FINAL ELECTRICAL